Provider Demographics
NPI:1487078630
Name:MIHALCIN, DEREK (PHD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:MIHALCIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 ALBRIGHT MCKAY RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-2848
Mailing Address - Country:US
Mailing Address - Phone:330-568-1835
Mailing Address - Fax:
Practice Address - Street 1:1704 NORTH RD SE
Practice Address - Street 2:SUITE #2
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2958
Practice Address - Country:US
Practice Address - Phone:330-856-4111
Practice Address - Fax:330-856-5839
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-08
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7108103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist